Nd-YAG Laser Therapy for Tracheobronchial Malignant Tumor

The neodymium-yttrium-aluminum-garnet (Nd-YAG) laser has proven to be a useful therapeutic tool for the management of endobronchial obstructive lesions. The purpose of this study was to reassess the present status of Nd-YAG laser therapy for tracheobronchial malignant tumors. Between February 1983 and December 1995 in 9 institutions, 82 patients received Nd-YAG laser therapy for tracheobronchial stenosis, obstruction, or hemoptysis due to tracheobronchial malignant tumors. Twelve patients received laser therapy alone. Perioperative radiotherapy was performed in 54 patients (66.6%). Metallic stents were inserted into the trachea or main stem bronchi in 19 patients and surgical treatment was performed in 13 patients following laser therapy. Six of the 7 patients with multiple lung cancer had undergone lobectomy for a first lesion, and received radiotherapy following laser treatments for a second or third cancer. Good symptomatic relief was obtained in 90.2% of the patients. The operative mortality rate was 0.55%, and the morbidity rate was 2.7%. Complications occurred in 5 patients : airway bleeding in 3, cardiac arrest in one and reocculusion in one. One patient died of uncontrollable bleeding. The median survival time was 8.9 months in the patients without surgical resection. The 5-year survival rate was 50.0% in the patients with surgical resection following Nd-YAG laser treatment. Nd-YAG laser therapy is useful as a palliative treatment of obstructive tracheobronchial disease. When the lesion is malignant, concurrent radiotherapy, insertion of stent or surgical resection is needed to prevent reobstruction.